The burden on our heads

It is now amply clear that India’s mental healthcare needs tectonic shifts in thinking and strategy.
Last Updated : 23 February 2020, 09:30 IST
Last Updated : 23 February 2020, 09:30 IST

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The mental healthcare sector in India has seen a lot of activity in the past five years. Perhaps the biggest shift has been the media space and attention this subject has received. We have witnessed unprecedented visibility for mental healthcare, backed by the fact that several celebrities and public figures have opened up; either about their own struggles with mental health issues or have expressed their views on the issue. This, no doubt, is a welcome sign as they help bring about incredible attitudinal shifts.

But I am jumping several layers here. Let me start from the beginning.

India’s mental healthcare landscape calls for drastic, urgent and tectonic shifts. And in several directions. Be it the patient-professional ratio or the prevalence of mental illness, every single data about mental health reflects a dismal situation. Stats tell us we have less than 5,000 psychiatrists in a country where one in five of us (260 million) have or are likely to have a mental health issue. It is also understood that the total number of mental health professionals put together in the country stands at a measly 10,000.

Furthermore, the key data that must worry us about mental healthcare is the treatment rate. The National Mental Health Survey of 2016 points out that more than 85 per cent of those with mental illness will never receive professional help! This should be extremely alarming to all of us. However, when we bring this data up in our discussions with people, they do not see the seriousness of the problem here. Imagine, if 85 per cent of those with malaria did not receive any treatment. Secondly, of those who receive professional help for their mental illness, most do after a prolonged delay.

The question we need to ask, therefore, is that why is it that most of those with mental illness do not receive professional care. And, when they do, why is it that there is such an inordinate delay in reaching out to the professionals. The answers depend on how we, as a community, perceive mental health.

Where is the infrastructure?

Just as any healthcare would demand, availability of and access to services is one of the most fundamental needs. There’s an alarming urgency to scale our services infrastructure. Greater number of mental health professionals, more hospital beds for patients, augmenting the healthcare workforce by offering basic skills to other medical and para health professionals and several other steps need to be taken so that we begin to serve every single person suffering from a mental illness.

The National Mental Healthcare Act aims to achieve this at several levels. Both the centre and the state governments have identified a set of objectives to ensure that citizens have easy access to mental healthcare across the country. While the pace of progress is slow here, there are some positive stories emerging in other pockets.

Necessity is the mother of...

The National Institute of Mental Health and Neuro Sciences (NIMHANS) runs the NIMHANS Digital Academy, which conducts several online courses for doctors and other health professionals on community mental health. These courses empower general physicians, nurses and other professionals to address mental healthcare in unserved communities.

Across the country, there are several non-profit organisations that are creating innovative models to provide effective and affordable mental healthcare with community involvement. ‘Sangath’ in Goa, ‘Atmiyata’ in Pune and ‘MHAT’ in Kozhikode are a few of them.

Technology is also playing a key role in ensuring service providers are innovatively catering to their potential patients. Several mental health professionals, today, offer online counselling and other services to those with mental health issues. Besides, there are chatbots that use artificial intelligence to aid people through their distresses. Given the dearth of service providers, these innovative delivery platforms are popular in smaller towns, too.

To address the massive gap in the mental healthcare service infrastructure, scaling up of innovative services and skilling on-ground enablers to serve wider geography is the immediate need. And, we have not even begun speaking about the quality of services delivered, which is another big challenge we are yet to discuss in the country.

The challenge of stigma

What may be unique to mental healthcare is the fact that merely the presence of services infrastructure may not guarantee that they will be accessed. There are several social challenges that people face before they make a decision to seek these services. Self-denial, social stigma, lack of knowledge of the subject and the resultant inability to recognise mental health issues are some of the reasons why we still do not readily seek out mental health professionals.

For several reasons, the presence of the right social infrastructure is a prerequisite for people with mental health issues to reach out and access services. Every single person who carries a view on mental illness is a stakeholder of the ecosystem as their views matter in the decision those with the illness and their caregivers make. An appropriate social infrastructure should, therefore, include the bystanders. Friends, extended family members, neighbours, school teachers and co-workers — all of us can be mental health allies.

Whether we are a person with an illness, a caregiver or a bystander, our decisions are largely based on our notions and beliefs on the subject. Even as we should stress on making services accessible, it is equally crucial that people are empowered with the right knowledge so that they have better decision-making capabilities. Given our deep-seated notions of mental health, it’s not just awareness but education, which is a slow process of realisation, acceptance, unlearning and relearning.

Do not ignore prevention

We are in the early stages of witnessing a movement in the mental healthcare space. However, in our efforts to address the needs of those with mental health problems, we should not forget the importance of prevention. Preventing mental health problems need to be seen from a holistic bio-psycho-social lens. Given the fact that scaling our services infrastructure to meet the growing demand will be a big challenge, investing in the prevention of mental health problems will be appropriate.

Data-hungry space

India’s mental healthcare practitioners, researchers, entrepreneurs and innovators constantly struggle with the lack of data. Data of all kinds — empirical, demographic, perceptive. The National Mental Health Survey of 2016 has been the most exhaustive survey ever conducted in the country. Given the complex nature of mental health issues and their correlations with several physiological, social, economic and cultural factors, we need to invest in gathering data. In this regard, the large-scale study by Lancet Psychiatry has provided us with fresh and comprehensive data. The study titled ‘The burden of mental disorders across the States of India: The Global Burden of Disease Study’ is important because it covers state-specific prevalence of mental health issues, often missing from Indian mental health research. In fact, until now, no study before this has been able to cover all 29 states and union territories.

The need for leaders

India’s mental healthcare needs a multi-dimensional transformation. This is impossible to achieve without leaders. From the health sector, political leadership, academicians to those from the Arts, mental health, too, is looking for leaders from different walks of life, who will envision a world where everyone will play a constructive role to bring about this transformation.

Even as we witness glimmers of hope with the increased presence of innovators in mental healthcare, we are still struggling to address the current grim situation. It will take us several years before we develop a firm grip. However, what India’s mental healthcare truly needs is future-ready solutions.

The author is the founding CEO of the White Swan Foundation for Mental Health, a mental health and well-being knowledge-service NGO.

Published 22 February 2020, 19:46 IST

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